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HIV Treatment Regimens CDC Guidelines, Adult/Adolescent 

  • Author: Jason F Okulicz, MD, FACP, FIDSA; more...
 
Updated: Aug 12, 2014
 
 

HIV Treatment Guidelines per the Centers for Disease Control

The Centers for Disease Control (CDC) and other federal government agencies have issued several guidelines and recommendations about the prevention, screening, diagnosis, treatment, and management of HIV infection.[1] The CDC references the most current Department of Health and Human Services (DHHS) guidelines for the use of antiretroviral agents in HIV-1–infected adults and adolescents[2] {[3] summarized below.

Initial combination regimens for antiretroviral-naive patients

An initial antiretroviral regimen generally consists of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), either tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC) plus one active drug from one of the following classes: nonnucleoside reverse transcriptase inhibitor (NNRTI), protease inhibitor (PI; boosted with ritonavir [RTV]), or integrase strand transfer inhibitor (INSTI).

Selection of a regimen should be individualized based on virologic efficacy, potential adverse effects, pill burden, dosing frequency, drug-drug interaction potential, the patient's resistance test results, comorbid conditions, and cost.

Recommended initial antiretroviral therapy (ART) regimen options for all patients, regardless of pre-ART viral load or CD4 cell count

See the list below:

Other recommended regimens

In addition to the regimens listed above, the following regimens are also recommended, but only for patients with a pre-ART plasma viral load of less than 100,000 copies/mL.

  • NNRTI-based regimens
  • PI-based regimen: ATV/r + ABC/3TC (only for patients who are HLA-B*5701 negative)

Alternative initial ART regimen options

These are regimens that are effective and tolerable but have potential disadvantages compared with the recommended regimens listed above or have less data from randomized clinical trials. An alternative regimen may be the preferred regimen for some patients.

  • PI-based regimens
    • DRV/r + ABC/3TC (only in patients who are HLA-B*5701 negative)
    • Lopinavir/ritonavir (LPV/r) (once or twice daily) + ABC/3TC (only for patients who are HLA-B*5701 negative)
    • Lopinavir/ritonavir (LPV/r) (once or twice daily) + TDF/FTC
  • INSTI-based regimen: RAL + ABC/3TC (only for patients who are HLA-B*5701 negative)
 
Contributor Information and Disclosures
Author

Jason F Okulicz, MD, FACP, FIDSA Director, HIV Medical Evaluation Unit, Infectious Disease Service, San Antonio Military Medical Center; Associate Professor of Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences; Clinical Associate Professor of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Clinical Instructor, Feik School of Pharmacy, University of the Incarnate Word

Jason F Okulicz, MD, FACP, FIDSA is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. CDC HIV/AIDS Guidelines and Recommendations. Available at http://www.cdc.gov/hiv/guidelines/index.html. Accessed: 3/21/14.

  2. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. May 1, 2014. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Accessed: June 27, 2014.

 
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